1. Fetal Alcohol Spectrum Disorders (FASD)

2. What is FASD? 2

3. Facts about FASD 3  FASD affects 1 in 100 live births  In Minnesota, more than 8,500 babies are born each year with prenatal exposure to alcohol (Cite: CDC, 2011/SAMHSA, 2006)  Nationally 1 in 13 pregnant women report alcohol use (CDC Morbidity and Mortality Weekly Report, July 20, 2012)  FASD occurs in all racial, ethnic and socioeconomic groups

4. FASD in comparison Three major known causes of intellectual disability Down Syndrome Fetal Alcohol Spectrum Disorders (FASD) Fragile X Syndrome Alcohol use during pregnancy is the leading known preventable cause of intellectual disabilities and birth defects in the United States. Source: National Institute on Alcohol Abuse and Alcoholism 4

5. What are Fetal Alcohol Spectrum Disorders (FASD)? A set of physical, behavioral, and cognitive disorders seen in individuals exposed to alcohol prenatally Lifetime disability with brain injury that never goes away Broad range (spectrum) of characteristics that vary from person to person 5

6. 6 The FASD Umbrella Fetal Alcohol Spectrum Disorders  Fetal Alcohol Syndrome (FAS)  Partial Fetal Alcohol Syndrome (pFAS)  Fetal Alcohol Effects (FAE) replaced by ARBD & ARND in 2006  Alcohol-Related Birth Defects (ARBD)  Alcohol-Related Neurodevelopmental Disorder (ARND)

7. Areas of Diagnostic Evaluation 1.Facial Dysmorphia 2.Growth Problems 3.Central Nervous System Abnormalities 4.History of Maternal Alcohol Exposure 7

8. FASD is NOT a diagnosis FAS Fetal Alcohol Syndrome PFAS Partial Fetal Alcohol Syndrome ARND Alcohol Related Neurodevelopmental Disorder ARBD Alcohol-Related Birth Defects FAE Fetal Alcohol Effects (Outdated term) 8

9. Alcohol is alcohol 9

10. Teratogen Alcohol is a teratogen—a substance that the fetus is exposed to that impedes growth and disrupts normal development. Spring 2013 MN Organization on Fetal Alcohol Syndrome 10

11. “No amount of alcohol consumption can be considered safe during pregnancy.” Surgeon General’s Advisory on Alcohol Use in Pregnancy - U.S. Surgeon General Richard H. Carmona, February 21, 2005. 11

12. Factors that affect each pregnancy Risks with Known Prenatal Alcohol Exposure: Not always going to result in an FASD Manifestations are unique in each individual Factors that affect each pregnancy: Blood alcohol concentration of the mother Binge drinking is especially harmful Timing of the exposure Resiliency of the fetus Metabolism and diet of the mother Source: Davies & Bledsoe, 2005 12

13. MN Organization on Fetal Alcohol Syndrome 13 National Organization on Fetal Alcohol Syndrome (NOFAS), 2004; Adapted from Moore, 1993. Feb 2013

14. Areas of the brain most affected

15. 15 Prenatal exposure to alcohol causes permanent brain injury that never goes away. Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

16. 16 FAS Facial Characteristics Thin upper lip Palpebral fissures Smooth, long philtrum CDC 2004 Might also have: Low set ears, flat mid-face, up-turned nose, small chin, and epicanthal folds. FAS Facial Characteristics – Image courtesy of FASTAR..

17. Ethnicities and Characteristic FAS Facial Features 17

18. 18

19. FASD is an invisible disability Attention deficits Hyperactivity Memory deficits Difficulty with abstract concepts Inability to manage money 19

20. Invisible Disability  Difficulty with the passage of time  Difficulty learning from consequences  Immature social behavior  Inappropriately friendly to strangers  Lack of control over emotions  Poor impulse control  Poor judgment 20

21. Sensory Challenges Sensory processing disorders – Brain “misreads” information from senses, which affects learning and behaviors Other challenges – Sensory seeking – Sensory avoiding 21

22. Behavior Challenges Hyperactivity/impulsiveness – ADHD common Stubborness – perseveration issues Passivity High-risk behaviors Sleep disorders Hypersensivity Depression Anxiety 22

23. Prenatal Alcohol Exposure and Information Processing MN Organization on Fetal Alcohol Syndrome 23 input (taking information in from the senses) integration (interpreting information, making sense of it) memory (storing information for later use, connecting with previous experiences) output (response, behavior) Feb 2013

24. Look at the chart and say the color not the word YELLOW BLUE ORANGE BLACK RED GREEN PURPLE YELLOW RED ORANGE GREEN BLACK BLUE RED PURPLE LEFT-RIGHT CONFLICT Your right brain tried to say the color but your left brain insists on reading the word. MN Organization on Fetal Alcohol Syndrome 24Feb 2013

25. Modify Expectations Individuals with an FASD may break rules repeatedly because they forget them or cannot apply them Accept that the individual may have unique learning challenges The emotional and social age of adults with an FASD is often lower than their chronological age 25

26. Strategies for Success Environmental modifications Social reminders Self-awareness Proactive, not reactive 26

27. Strategies for Success Timers Picture schedules Songs Routines 27

28. Recognize strengths Highly verbal Artistic, musical Athletic Long-term visual memory Willing Helpful Loyal Generous Hard working, energetic Forgiving Spontaneous Friendly, outgoing Want to succeed 28

29. Don’t Try Harder Try Differently If you’ve told a child a thousand times and he still does not understand, then it is not the child who is the slow learner. - Walter Barbee MN Organization on Fetal Alcohol Syndrome 29Feb 2013

30. Resources

31. Online Resources General Information on FASD – Center for Disease Control and Prevention, FAS site http://www.cdc.gov/ncbddd/fas – FASD Unit @ the Univ of Washington School of Medicine http://depts.washington.edu/fadu/ – MOFAS Resource Directory – http://www.mofas.org MN Organization on Fetal Alcohol Syndrome 31 MN Organization on Fetal Alcohol Syndrome 31 Feb 2013

32. Contact Information: MOFAS Phone: 651-917-2370 www.mofas.org